Healthcare Provider Details

I. General information

NPI: 1588568414
Provider Name (Legal Business Name): GABRIELLA MESQUITA OVERBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 W 15TH ST
WASHINGTON NC
27889-3533
US

IV. Provider business mailing address

930 W 15TH ST
WASHINGTON NC
27889-3533
US

V. Phone/Fax

Practice location:
  • Phone: 252-495-4572
  • Fax: 888-509-1502
Mailing address:
  • Phone: 252-495-4572
  • Fax: 888-509-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPO20833
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: